Coding Auditor, Senior Associate

Gainwell Technologies LLC•Any city, OH

12d•$54,100 - $77,300•Remote

About The Position

Gainwell Technologies is seeking a Senior Associate to perform coding reviews of medical records and other documentation, determining correct coding according to the review methodologies for the applicable contract. The role involves using proprietary systems to audit records, documenting findings accurately, and supporting determinations with policy and regulatory guidance. The candidate should have an extensive background in facility-based inpatient coding and/or outpatient coding edits and a strong understanding of reimbursement guidelines, including MS-DRG, AP-DRG, APR-DRG, ASC, and APC payment systems. The position is remote within the United States. It offers benefits from the first day of employment and opportunities for advancement through training and leadership development. Salaried, full-time employees are eligible for a flexible vacation policy, a 401(k) employer match, comprehensive health benefits, educational assistance, and leadership and technical development academies.

Requirements

At least one year of active professional credentials through AHIMA or AAPC: CPC, CCS, COC, RHIA, or RHIT.
At least three years of inpatient or outpatient claims coding experience.
Proficiency in medical record auditing and ICD-10-CM, ICD-10-PCS, APC, ASC, HCPCS, and CPT coding methodology.
Thorough understanding of APR-DRG, AP-DRG, and MS-DRG.
Experience in medical record coding and auditing.

Responsibilities

Audit medical record documentation to determine the accuracy of principal and secondary diagnoses, including MCCs and CCs, and procedure codes.
Apply official coding guidelines, coding clinics, and regulatory guidelines and mandates; use advanced ICD-10 coding expertise to support conclusions.
Use HMS proprietary auditing systems to document audit determinations and rationale.
Meet productivity and quality standards established by management.
Cross-train to review multiple claim types to support client needs.
Assist management in training new Coding Auditors through daily monitoring, mentoring, feedback, and education.
Maintain current knowledge of coding guidelines and complete required continuing education units to maintain coding certification.
Attend training and scheduled meetings to improve skills and knowledge of clinical policies, procedures, rules, and regulations.